OBJECTIVES:HIV self-testing (HIVST) through community pharmacies offers a complementary, confidential and convenient testing option. Despite the availability of HIVST kits in Belgian pharmacies since 2017, little is known about sales and pharmacists' experiences. This study assessed HIVST sales and pharmacists' knowledge, attitudes and perceptions regarding its provision. METHODS:We conducted a cross-sectional web-based survey among all community pharmacies (~4700) in Belgium between 14 May and 31 July 2025. Participants were recruited via newsletters from national and regional pharmacists' associations and a pharmacy network. We analysed responses on HIVST sales and pharmacists' knowledge, attitudes and perceptions descriptively. Associations between sales and pharmacy or pharmacist characteristics were examined using χ2, Fisher's exact or Mann-Whitney tests. RESULTS:Among 235 respondents, 33.2% (78/235) reported selling HIVST, of whom 69.2% (54/78) sold ≤2 kits annually. Most sold the finger-prick Autotest HIV (65/78, 83.3%). Retail prices ranged from €26 to €35 (58/78, 74.4%). Half procured kits on request (37/78, 47.4%), only 12.8% (10/78) displayed kits. Sales were associated with pharmacist age (p=0.04) and location, with Brussels pharmacies more likely to sell kits than those in Flanders or Wallonia (p<0.001). Selling ≥3 HIVST kits annually occurred in 90.0% (9/10) of respondents with kits visibly displayed, compared with 41.4% (12/29) for behind-the-counter storage and 5.4% (2/37) for on-request provision (p<0.001). While 76.6% (180/235) considered HIVST a valuable complement to facility-based testing, only 19.6% (46/235) actively recommended it. Only 15.3% (36/235) had attended HIVST training; 31.9% (75/235) reported discomfort advising clients due to limited experience (85.3%) or low knowledge (78.7%). CONCLUSIONS:The opportunity to purchase HIVST in community pharmacies remains underutilised in Belgium. Enhancing pharmacists' training, confidence, visibility of kits and affordability may increase uptake, strengthening the role of pharmacists as complementary providers of HIVST. Future research should include clients' perspectives on HIVST.

OBJECTIVES:Globally, curable sexually transmitted infections (STIs) are increasing, particularly in sub-Saharan Africa, yet epidemiological data remain limited, hindering progress towards the 2030 global STI targets. This study assessed the prevalence of self-reported STIs in the last 12 months among adolescent girls and women (AGW) and adolescent boys and men (ABM) aged 15-59 who ever had sex in Zambia and Zimbabwe at three time points. It also assessed whether observed changes across survey rounds persisted after adjusting for sociodemographic and sexual behaviour characteristics. DESIGN:We analysed six rounds of Demographic and Health Surveys, three per country, collected between 2005 and 2018, using descriptive statistics and logistic regression, while accounting for survey design. SETTING:Zambia and Zimbabwe. PARTICIPANTS:A total weighted sample of 86 366 AGW and ABM was included in the study. OUTCOME MEASURE:Self-reported STIs in the last 12 months. RESULTS:Overall, self-reported STI prevalence was higher in Zimbabwe than Zambia. Among Zambian ABM, self-reported STIs increased from 6.2% in 2007 to 7.1% in 2018 (adjOR=1.28, 95% CI 1.05 to 1.57, p=0.005). Among Zimbabwean AGW, prevalence decreased from 11.7% in 2005/2006 to 8.3% in 2015 (adjOR=0.72, 95% CI 0.61 to 0.85, p<0.001). No significant differences between survey rounds were observed among AGW in Zambia (2007: 5.2%, 2018: 5.1%, adjOR=1.01, 95% CI 0.83 to 1.22, p=0.070) and ABM in Zimbabwe (2005/2006: 7.9%, 2015: 8.4%; adjOR=1.13, 95% CI 0.92 to 1.38, p=0.371). Self-reported STIs were associated with marital status, HIV status and number of sexual partners in the last 12 months among ABM and AGW. Among ABM, self-reported STIs decreased with older age at sexual debut. In Zimbabwe, lower educational attainment and wealth were also associated with higher STI prevalence. CONCLUSION:These findings highlight differences in STI prevalence by sex and country across survey rounds, underscoring the need for tailored STI prevention, diagnostic and treatment strategies, particularly for high-risk groups.

A better understanding of HIV transmission dynamics is needed to further reduce the number of new HIV diagnoses in Belgium. As environmental and social context play an important role in explaining HIV acquisition despite the availability of effective HIV prevention, this study investigated how social and sexual networks may have influenced HIV prevention and risk behavior among a group of people newly diagnosed with HIV, including their perceptions of how they acquired HIV and their ability to disclose their HIV status. We used an ego-centric social network approach, generating sociograms of social and sexual networks through in-depth interviews with 20 participants newly diagnosed with HIV. Many participants reported a considerable overlap between their social and sexual networks. Friends, family members, regular sex partners and HIV physicians were placed closest to the ego on the sociogram. Self-identified gay men did not consider their casual sex partners as emotionally close enough to be included in the sociogram, despite these partners often being participants’ primary source of information about sexual health. Self-identified heterosexual and bisexual men who have sex with men (MSM) had more diverse and separated networks, and often had not considered themselves at risk for HIV. They were less aware of PrEP compared to self-identified gay MSM, partly attributed to target-group specific community-based prevention efforts. Most participants disclosed HIV only to those closest to them, and the anticipated and perceived lack of social support influenced acceptance. Feelings of internalized HIV stigma and homophobia prevented HIV disclosure, especially among heterosexuals and heterosexual and bisexual MSM. This study revealed important differences in the networks of gay-identified MSM, heterosexuals and hetero- and bisexual identified MSM influencing sexual risk taking and prevention behavior. Future prevention initiatives should be inclusive and mainstreamed to ensure to address those who do not identify as belonging established key populations. Awareness of HIV and biomedical prevention should be raised in the general population, providing a base on which tailored prevention can be built. Involving family physicians and socially empowering people living with HIV may help to decrease anticipated and internalized HIV stigma.

Abstract Introduction In 2023, one‐fourth of new HIV acquisitions in children globally resulted from vertical transmission following incident HIV during pregnancy or breastfeeding. Oral pre‐exposure prophylaxis (PrEP) with tenofovir disoproxil and emtricitabine is safe and effective in pregnancy and postpartum, with long‐acting options emerging. Integrating PrEP into antenatal and postnatal care (ANC/PNC) is a crucial person‐centred approach to prevent maternal HIV acquisition and vertical transmission. This review summarizes oral PrEP initiation, continuation and adherence among pregnant and postpartum women receiving ANC/PNC. Methods We systematically searched three databases for English‐language quantitative studies published between 1 January 2015 and 28 March 2024. Eligible studies focused on pregnant and/or postpartum women accessing PrEP through ANC/PNC, and reported on initiation (receipt of prescription or self‐reported use), continuation (persistent use over time) and/or adherence (self‐reported and/or objective). Results We identified 481 articles; 12 studies from Kenya, Lesotho, Malawi and South Africa met our inclusion criteria. Study heterogeneity (e.g. definitions used, population included, follow‐up time) precluded meta‐analysis. All studies enrolled pregnant women; three also enrolled postpartum women. Median gestational age at enrolment ranged from 20 to 26 weeks, and follow‐up periods from 1 month post‐enrolment to 12 months postpartum. Oral PrEP initiation ranged from 14% to 84%. Continuation at 3 months ranged from 22% to 90% and declined postpartum in all studies. Self‐reported adherence (daily use) ranged from 11% to 81% in the past 7 or 30 days at 1 month (four studies) and from 54% to 81% at 3 months (two studies). Objectively measured adherence ranged from 34% to 62% for detectable tenofovir or tenofovir diphosphate levels at 1 month (three studies). One Kenyan trial demonstrated that universal versus risk‐based offers of oral PrEP resulted in similar PrEP use and HIV incidence. Two‐way SMS communication (Kenya) and real‐time adherence biofeedback counselling using urine tenofovir testing (South Africa) enhanced PrEP continuation/adherence compared to standard‐of‐care. Discussion Integrating oral PrEP into ANC/PNC showed high initiation among pregnant/postpartum women; however, continuation and adherence were suboptimal. Conclusions Oral PrEP integration into ANC/PNC can reach pregnant/postpartum women. Maximizing its impact will require offering long‐acting PrEP, person‐centred interventions to support adherence/continued use and differentiated delivery responsive to women's needs. PROSPERO Number CRD42024513442

In Sub-Saharan Africa, unmet need for contraceptives often remains high among adolescent girls and young women (AGYW), leading to unintended pregnancies. Yathu Yathu, a cluster-randomised trial of a community-based intervention conducted in two communities in Lusaka, Zambia (2019–2021), aimed to provide sexual and reproductive health services, including contraceptive services, to adolescents and young people. The trial showed no impact on pregnancy related outcomes. Hence, this analysis examined the characteristics of AGYW aged 15–24 with an unmet need for modern contraceptives and who experienced an unintended pregnancy. We also explored access to and reach of contraceptive services through Yathu Yathu. Secondary analysis of Yathu Yathu endline survey data. Using logistic regression, adjusted for cluster, we explored factors associated with unmet need for modern contraceptives and unintended pregnancies among AGYW in the intervention arm and assessed whether these associations differed in the control arm. Using routinely collected service delivery data from the intervention arm, numbers of AGYW accessing hormonal contraceptive services were described by age, community, educational attainment, and marital status. In the intervention arm, 395 AGYW ever had sex. Unmet need for modern contraceptives was 40.6 https://clinicaltrials.gov/ct2/show/NCT04060420 ; and ISRCTN75609016. Registration date: 2019-08-12.

INTRODUCTION:In Belgium, oral HIV pre-exposure prophylaxis (PrEP) is primarily provided in specialized clinical settings. Optimal implementation of PrEP services can help to substantially reduce HIV transmission. However, insights into implementation processes, and their complex interactions with local context, are limited. This study examined factors that influence providers' adaptive responses in the implementation of PrEP services in Belgian HIV clinics. METHODS:We conducted a qualitative multiple case study on PrEP care implementation in eight HIV clinics. Thirty-six semi-structured interviews were conducted between January 2021 and May 2022 with a purposive sample of PrEP care providers (e.g. physicians, nurses, psychologists), supplemented by 50 hours of observations of healthcare settings and clinical interactions. Field notes from observations and verbatim interview transcripts were thematically analysed guided by a refined iteration of extended Normalisation Process Theory. RESULTS:Implementing PrEP care in a centralized service delivery system required considerable adaptive capacity of providers to balance the increasing workload with an adequate response to PrEP users' individual care needs. As a result, clinic structures were re-organized to allow for more efficient PrEP care processes, compatible with other clinic-level priorities. Providers adapted clinical and policy norms on PrEP care (e.g. related to PrEP prescribing practices and which providers can deliver PrEP services), to flexibly tailor care to individual clients' situations. Interprofessional relationships were reconfigured in line with organizational and clinical adaptations; these included task-shifting from physicians to nurses, leading them to become increasingly trained and specialized in PrEP care. As nurse involvement grew, they adopted a crucial role in responding to PrEP users' non-medical needs (e.g. providing psychosocial support). Moreover, clinicians' growing collaboration with sexologists and psychologists, and interactions with PrEP users' family physician, became crucial in addressing complex psychosocial needs of PrEP clients, while also alleviating the burden of care on busy HIV clinics. CONCLUSIONS:Our study in Belgian HIV clinics reveals that the implementation of PrEP care presents a complex-multifaceted-undertaking that requires substantial adaptive work to ensure seamless integration within existing health services. To optimize integration in different settings, policies and guidelines governing PrEP care implementation should allow for sufficient flexibility and tailoring according to respective local health systems.

BACKGROUND:Since June 2017, oral pre-exposure prophylaxis (PrEP) has been reimbursed in Belgium for people at substantial risk of HIV. To inform the national PrEP programme, we described sociodemographic characteristics of PrEP users, PrEP dispensing practices, testing for HIV and sexually transmitted infections (STIs; gonorrhoea, chlamydia and syphilis), and incidence of HIV and STIs. METHODS:Analysis of routinely collected social health insurance claims data from all individuals who were dispensed at least one PrEP prescription between June 2017 and December 2019. Using logistic regression adjusted for age, we examined associations between sociodemographic characteristics and having been dispensed PrEP only once in the first six months of PrEP use. RESULTS:Overall, 4559 individuals were dispensed PrEP. Almost all PrEP users were male (99.2%, 4522/4559), with a median age of 37 years (IQR 30-45). A minority were entitled to an increased healthcare allowance (11.4%, 514/4559). 18% (657/3636) were dispensed PrEP only once in the first six months of PrEP use. PrEP users younger than 25 years, unemployed, entitled to an increased healthcare allowance, and who initiated PrEP between January 2019 and June 2019 were more likely to have had no PrEP dispensing after initiation compared to their counterparts. The testing rates for bacterial STIs and HIV were 4.2 tests per person-year (95% CI 4.1-4.2) and 3.6 tests per person-year (95% CI 3.5-3.6), respectively. Twelve individuals were identified to have seroconverted during the study period, resulting in an HIV incidence rate of 0.21/100 person-years (95% CI 0.12-0.36). The incidence of bacterial STIs was 81.2/100 person-years (95% CI 78.7-83.8). CONCLUSIONS:The study highlights challenges in PrEP persistence and a high incidence of bacterial STIs among individuals receiving PrEP. Tailored prevention support is crucial for individuals with ongoing HIV risk to optimise PrEP effectiveness. Integrated STI testing and prevention interventions within PrEP care are necessary to mitigate STI acquisition and transmission among PrEP users.

BACKGROUND:Guidelines recommend screening for Neisseria gonorrhoeae and Chlamydia trachomatis at three anatomical sites (urethra, anus, and pharynx) every 3 months (3 × 3) in men who have sex with men (MSM) and transgender women taking HIV pre-exposure prophylaxis (PrEP). We present the first randomised controlled trial to compare the effect of screening versus non-screening for N gonorrhoeae and C trachomatis on the incidence of these infections in MSM and transgender women taking PrEP. METHODS:A multicentre, randomised, controlled trial of 3 × 3 screening for N gonorrhoeae and C trachomatis versus non-screening was done among MSM and transgender women taking PrEP in five HIV reference centers in Belgium. Participants attended the PrEP clinics quarterly for 12 months. N gonorrhoeae and C trachomatis was tested at each visit in both arms, but results were not provided to the non-screening arm, if asymptomatic. The primary outcome was incidence rate of N gonorrhoeae and C trachomatis infections in each arm, assessed in the per-protocol population. Non-inferiority of the non-screening arm was proven if the upper limit of the 95% CI of the incidence rate ratio (IRR) was lower than 1·25. This trial is registered with ClinicalTrials.gov, NCT04269434, and is completed. FINDINGS:Between Sept 21, 2020, and June 4, 2021, 506 participants were randomly assigned to the 3 × 3 screening arm and 508 to the non-screening arm. The overall incidence rate of N gonorrhoeae and C trachomatis was 0·155 cases per 100 person-days (95% CI 0·128-0·186) in the 3 × 3 screening arm and 0·205 (95% CI 0·171-0·246) in the non-screening arm. The incidence rate was significantly higher in the non-screening arm (IRR 1·318, 95% CI 1·068-1·627). Participants in the non-screening arm had a higher incidence of C trachomatis infections and symptomatic C trachomatis infections. There were no significant differences in N gonorrhoeae infections. Participants in the non-screening arm consumed significantly fewer antimicrobial drugs. No serious adverse events were reported. INTERPRETATION:We failed to show that non-screening for N gonorrhoeae and C trachomatis is non-inferior to 3 × 3 screening in MSM and transgender women taking PrEP in Belgium. However, screening was associated with higher antibiotic consumption and had no effect on the incidence of N gonorrhoeae. Further research is needed to assess the benefits and harms of N gonorrhoeae and C trachomatis screening in this population. FUNDING:Belgian Health Care Knowledge Centre.

ObjectivesWe aimed to assess the awareness, willingness to use and use of doxycycline post-exposure prophylaxis (doxyPEP) among men who have sex with men (MSM) and transgender women (TGW) in Belgium. Additionally, we aimed to identify factors associated with doxyPEP use and concerns regarding antimicrobial resistance (AMR).MethodsCross-sectional online survey among MSM and TGW in Belgium in April 2024. Participants were recruited through sexual networking applications and social media of community-based organisations. Numerical variables were compared with Wilcoxon rank-sum test and categorical variables with χ2or Fisher’s exact tests. Factors associated with doxyPEP use were assessed using logistic regression. Willingness to use doxyPEP and concerns about side effects/AMR were assessed before and after presenting a brief paragraph on the potential effects of doxyPEP on AMR.Results875 individuals initiated the survey. Almost all identified as men (860/875, 98.3%) with a median age of 40 years (IQR 32–48), 40.4% (n=352/875) had heard of doxyPEP and 9.4% (n=82/875) had used it, among whom the majority used it within the previous 6 months (70/81, 86.4%). In multivariable logistic regression, doxyPEP use was associated with reporting ≥1 sexually transmitted infection (STI) in the previous 12 months, engagement in chemsex, HIV status and pre-exposure prophylaxis use, and education level.About 80% of the participants initially reported being willing to use doxyPEP, and about 50% reported being concerned about side effects. After reading about the potential effects of doxyPEP on AMR, willingness to use decreased to 60% and concerns of side effects/AMR increased to around 70%.ConclusionsApproximately 1 in 10 MSM in Belgium reported using doxyPEP. A recent history of STIs and STI risk factors were positively associated with doxyPEP use. Importantly, concerns about AMR and side effect influenced willingness to use doxyPEP. If doxyPEP is introduced, informing patients about doxyPEP benefits and risks is crucial to enable informed decision-making.

In Belgium, HIV pre-exposure prophylaxis (PrEP) services are mainly provided through specialised HIV clinics. To optimise PrEP uptake and retention in care, we require insights into users’ perspectives on PrEP care. We aimed to elicit experiences with, and preferences for, PrEP service delivery among PrEP users in Belgium, including willingness to involve their family physician (FP) in PrEP care. We adopted a sequential mixed-methods design. We used a web-based longitudinal study among 326 PrEP users that consisted of two questionnaires at six-month intervals, and complemented this with 21 semi-structured interviews (September 2020-January 2022). We conducted descriptive analyses and logistic regression to examine factors associated with willingness to involve their FP in PrEP care. Interviews were analysed using thematic analysis. Survey respondents reported high satisfaction with care received in HIV clinics [median score 9 (IQR 8–10), 10=’very satisfied’]. Interviews revealed the importance of regular HIV/STI screening, and the expertise and stigma-free environment of HIV clinics. Yet, they also contextualised service delivery barriers reported in the questionnaire, including the burden of cost and challenges integrating PrEP visits into their private and professional lives. Although 63.8

Non-consensual sex poses a threat not only to sexual health but also to mental and physical health in general. HIV pre-exposure prophylaxis (PrEP) users might be particularly vulnerable to non-consensual sex because of interplaying factors such as mental health disorders, a high number of sex partners, engagement in chemsex, and the widespread use of dating apps. The objectives of this study were to assess the occurrence of non-consensual sex, its associated factors, and related help-seeking behavior among PrEP users. We analyzed data from an online survey among PrEP users in Belgium (09/2020-02/2022). Almost one in five participants (34/187, 18.2%) reported having ever experienced non-consensual sex. The most reported form was having sex against one's will, followed by having been given drugs against one's will, and having had sex without a condom against one's will. The vast majority of those who had experienced non-consensual sex (29/34, 85.3%) did not seek help afterward, mostly due to a lack of perceived need (21/29, 72.4%). Reported barriers to seeking help were shame (6/29, 20.7%) and lack of awareness of help services (3/29, 10.3%). Having experienced non-consensual sex in the past five years was associated with younger age and suicidal ideation in a multivariable logistic regression model. We conclude that addressing barriers to non-consensual sex help services is crucial to maximize their use and minimize the consequences of non-consensual sex experiences. PrEP consultations also represent an opportunity to offer such help given PrEP users are already familiar with these PrEP services and engaged in care.

BackgroundPrEP uptake is low among non-Belgian men and transwomen who have sex with men, although the HIV epidemic among men who have sex with men in Belgium is diversifying in terms of nationalities and ethnicity. We lack an in-depth understanding of this gap.MethodsWe conducted a qualitative study using a grounded theory approach. The data consists of key informants interviews and in-depth interviews with migrant men or transwomen who have sex with men.ResultsWe identified four underlying determinants which shape our participants' experiences and contextualize the barriers to PrEP use. These include (1) the intersectional identities of being migrant and men and transwomen who have sex with men, (2) migration related stressors, (3) mental health and (4) socio-economic vulnerability. Identified barriers include: the accessibility of services; availability of information, social resources and providers' attitudes. These barriers influence PrEP acceptance and mediated by individual agency this influences their PrEP uptake.ConclusionAn interplay of several underlying determinants and barriers impacts on PrEP uptake among migrant men and transwomen who have sex with men, illustrating a social gradient in access to PrEP. We need equitable access to the full spectrum of HIV prevention and care for all priority populations, including undocumented migrants. We recommend social and structural conditions that foster exercising these rights, including adapting PrEP service delivery, mental health and social support.

Summary Background Guidelines recommend three-site (urine, anal, pharynx) three-monthly (3X3 screening) screening for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in men who have sex with men (MSM) taking HIV pre-exposure prophylaxis (PrEP). We present the first randomized controlled trial to compare the effect of screening versus non-screening for NG/CT on the incidence of these infections in MSM taking PrEP. Methods A multicenter, randomized, controlled trial of 3X3 screening for NG/CT versus non-screening was conducted among MSM taking PrEP in five HIV reference centers in Belgium. Participants attended the PrEP clinics quarterly for 12 months. NG/CT was tested at each visit in both arms, but results were not provided to the non-screening arm. The primary outcome was the incidence rate (IR) of NG/CT infections in each arm, assessed in the per-protocol population. Non-inferiority of the non-screening arm was proven if the upper limit of the 95% confidence interval of the IR ratio (IRR) was lower than 1.25. The trial protocol was registered at clinicaltrials.gov ( NCT04269434 ). Findings Between September 2020 and June 2021, 508 subjects were randomized to the 3X3 screening arm and 506 to the non-screening arm. The overall IR of NG/CT was 0.155 cases/100 person-days (95%CI 0.128-0.186) in the 3×3 screening arm and 0.205 (95%CI 0.171-0.246) in the non-screening arm. The IR was significantly higher in the non-screening arm (IRR 1.318, 95%CI 1.068-1.627). Participants in the non-screening arm had a higher incidence of CT infections and symptomatic CT infections. There were no significant differences in NG infections. Participants in the non-screening arm consumed significantly less antimicrobials. No serious adverse events were reported. Interpretation We failed to show that non-screening for NG/CT is non-inferior to 3-site 3-monthly screening in MSM taking PrEP in Belgium. However, screening was associated with higher antibiotic consumption and had no effect on the incidence of NG. Therefore, our findings do not provide strong support for screening for NG/CT in this population. Funding Belgian Healthcare Knowledge Center (KCE - INV18-1133)

Background Tailoring pre-exposure prophylaxis (PrEP) service delivery is key to scaling-up PrEP uptake. Optimal implementation of tailored services requires, among other things, insights into patterns of PrEP use, sexual behaviours and condom use over time. Methods Between September 2020 and January 2022, we conducted a web-based, longitudinal study among PrEP users in Belgium. In three questionnaire rounds every six-months, we assessed PrEP and condom use, and sex with steady, casual and anonymous partners in the preceding three months. Based on the patterns of PrEP use in the preceding three months, we identified distinct PrEP use categories. We investigated differences in baseline socio-demographics and sexual behaviours by PrEP use category using Fisher’s exact and one-way ANOVA tests. Patterns in PrEP and condom use over time were examined using descriptive analyses and visualised in alluvial diagrams. Results In total, 326 participants completed the baseline questionnaire, and 173 completed all three questionnaires. We identified five distinct PrEP use categories: daily (≥ 90 pills), almost daily (75–89 pills), long period (> 7 consecutive days and < 75 pills) with or without additional short period use, short period (1–7 consecutive days and < 75 pills) and no PrEP use (0 pills). During the study, percentages of individuals in each PrEP use category varied, but did not change significantly over time. At baseline, daily and almost daily users were more likely to report five or more casual sex partners, ten or more anonymous sex partners and anal sex on a weekly basis with casual or anonymous partners compared to those using PrEP for long or short periods. Up to 12.6% (n = 16/127) of participants reporting anal sex with casual or anonymous partners, indicated always using condoms and PrEP with these partners. One in three (n = 23/69) participants who reported anal sex with steady partners had condomless anal sex and did not use PrEP with these partners; with casual or anonymous partners less than 3% reported this. Conclusions Our findings show that there is little variation in PrEP use over time and that PrEP use was associated with sexual behaviours, which could be taken into account when designing tailored PrEP care.

Background: Worldwide, 1.7 million children younger than 15 years were living with HIV in 2021. Only 52% of them had access to antiretrovirals (ARVs). Lack of age-appropriate ARV formulations (i.e. easy to swallow for young infants, acceptable taste) remains the main obstacle to the access to ARVs. Therefore, a strawberry-flavoured Abacavir/Lamivudine/Lopinavir/Ritonavir (30/15/40/10 mg) fixed-dose combination of granules in a capsule (4-in-1) for children living with HIV weighing 3–25 kg was developed. Objective: We assessed caregivers’ perceived acceptability of the 4-in-1 compared with previous paediatric ARV formulations and factors influencing acceptability. Methods: This exploratory qualitative case study embedded in a phase I/II, open-label, randomized cross-over pharmacokinetic, safety and acceptability study (LOLIPOP) was conducted in three sites in Uganda (May 2019–October 2020). Thirty-six children weighing between 3 and 19.9 kg participated in the main study. We purposively sampled caregiver–child dyads according to weight bands, and conducted 20 semi-structured interviews with caregivers and 5 with healthcare providers. We triangulated these results with a quantitative acceptability questionnaire. We analysed interviews inductively using NVivo12 adopting a thematic analysis approach and acceptability questionnaires descriptively to assess concordance between them. Results: All caregivers found the 4-in-1 formulation highly acceptable and easier to use than previous formulations (i.e. pellets/tables/syrup). Appealing taste, ease of administration, easy storage and children’s acceptance contributed to acceptability despite structural challenges of food shortage and HIV stigma. Visible improvements in children’s health and comprehensive and tailored healthcare provider support to overcome initial difficulties such as vomiting increased caregivers’ acceptance. Concordant results from questionnaire- and interview-data confirmed high acceptability. Conclusion: Caregivers of children in all weight bands in this sample found the 4-in-1 granules highly acceptable compared with the pellets/tablets combination. Healthcare providers’ support to caregivers allowed for individual tailoring of drug administration despite challenges such as food shortage. This enabled short-term adherence. These findings informed further practical recommendations. Registration: Clinical trial number: NCT03836833

BACKGROUND:Chemsex involves the use of psychoactive drugs in a sexual context and is a growing phenomenon among men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users. Investigating how its negative consequences can be avoided is important. The objective of this study was to explore the perceived impact of chemsex, the willingness to reduce chemsex activities and associated risks and preferred interventions to do so among PrEP users.METHODS:We analysed data from an online survey among PrEP users in Belgium. Chemsex was assessed in two questionnaires distributed between September 2020 and January 2022.RESULTS:A total of 326 participants completed the baseline questionnaire, and 186 the follow-up questionnaire. About one in three participants (36.5%, 119/326) reported engaging in chemsex, and half of those (49.6%, 59/119) were willing to reduce chemsex-related risks. The most preferred strategies for reducing risks were online support via an app (37.3%, 22/59) and face-to-face counselling with a health care professional (30.5%, 18/59). Among those reporting recent chemsex in the follow-up questionnaire, about one in five (21.9%, 14/64) wanted to reduce or stop chemsex activities. About 23.4% (15/64) also reported experiencing negative consequences of chemsex on their health, social or professional life.CONCLUSION:Our findings show that one in four PrEP users engaging in chemsex experienced negative consequences of these activities and about one in five was willing to reduce or stop chemsex activities. We recommend embedding comprehensive chemsex support in the PrEP package of care and developing novel tools and interventions in order to reach maximum impact.

Background No randomized controlled trial (RCT) has compared the impact on the resistome of ceftriaxone (CRO) plus azithromycin (AZM) vs CRO for the treatment of Neisseria gonorrhoea (NG).Methods This was an open-label, single-center, RCT comparing the effect on the resistome of CRO plus AZM vs CRO for the treatment of NG. Men who have sex with men (MSM) with genital, anorectal, or pharyngeal NG infection were randomized into the CRO/AZM and CRO arms. Oral rinse and anorectal samples were taken for culture and resistome profiling at 2 visits (baseline and day 14). The primary outcome was the ratio of mean macrolide resistance determinants in anorectal samples from day 14 between arms.Results Twenty individuals were randomized into the CRO/AZM arm and 22 into the CRO arm. We found no significant difference in the mean macrolide resistance determinants in the day 14 anorectal samples between arms (ratio, 1.05; 95% CI, 0.55-1.83; P = .102). The prevalence of baseline macrolide resistance was high (CRO/AZM arm = 95.00%; CRO arm = 90.91%).Conclusions We could not demonstrate a significant effect of dual CRO/AZM therapy on the resistome compared with CRO alone, likely due to a high baseline resistance to AZM. Interventions to prevent the emergence of antimicrobial resistance in MSM are needed.

INTRODUCTION:The number of individuals initiating antiretroviral pre-exposure prophylaxis (PrEP) is increasing, but we do not fully understand who is coming forward for PrEP, how they use it and how they are followed-up. The objective of this study was to examine PrEP user profiles, dynamics in PrEP use and follow-up over time. METHODS:We conducted a cohort analysis of longitudinally collected clinical record and questionnaire data among PrEP users at an HIV centre in Antwerp, Belgium, between June 2017 and March 2020. PrEP follow-up and user profiles were examined using descriptive analyses and bivariate logistic regression. We compared early adopting PrEP users (started before June 2018) with late users. We also calculated the probabilities of switching between daily and on-demand PrEP, and interruption, using a naïve estimator. RESULTS AND DISCUSSION:We included 1347 PrEP users in the analysis. After 12 months, retention in care was 72.3%. Median time between PrEP visits was 98 days (IQR 85-119 days). At screening visit, early adopting PrEP users (starting June 2017-May 2018) were significantly more likely to report one or more sexually transmitted infection in the prior 12 months, having used drugs during sex, a higher number of sexual partners and a history of paid sex and PrEP use prior to initiation, compared with PrEP users who initiated later (starting June 2018-February 2020). When taking PrEP daily, the probability of staying on daily PrEP at the next visit was 76%, while this was 73% when taking PrEP on-demand. Those using on-demand PrEP had a higher probability (13%) of interrupting PrEP care than daily PrEP users (7%), whereas those returning to PrEP care would mostly re-start with on-demand (35% vs. 13% for daily). CONCLUSIONS:The majority of PrEP users in this sample remained in care after 12 months. The probability of remaining on the same PrEP regimen at the subsequent visit was high. Though, we observed a diversity of transitions between regimens and interruptions in between visits. Our findings reaffirm the need to provide tailored PrEP services, counselling PrEP users across their life course.

Background Several trials of community-based HIV self-testing (HIVST) provide evidence on the acceptability and feasibility of campaign-style distribution to reach first-time testers, men and adolescents . However, we do not know how many remain unaware of HIVST after distribution campaigns, and who these individuals are. Here we look at factors associated with never having heard of HIVST after community-based campaign-style HIVST distribution in rural Zimbabwe between September 2016 and July 2017. Methods Analysis of representative population-based trial survey data collected from 7146 individuals following community-based HIVST distribution to households was conducted. Factors associated with having never heard of HIVST were determined using multivariable mixed-effects logistic regression adjusted for clustered design. Results Among survey participants, 1308 (18.3%) self-reported having never heard of HIVST. Individuals who were between 20 and 60 years old {20–29 years: [aOR = 0.74, 95% CI (0.58–0.95)], 30–39 years: [aOR = 0.56, 95% CI (0.42–0.74)], 40–49 years: [aOR = 0.50, 95% CI (0.36–0.68)], 50–59 years [aOR = 0.58, 95% CI (0.42–0.82)]}, who had attained at least ordinary level education [aOR = 0.51, 95% CI (0.34–0.76)], and who had an HIV test before [aOR = 0.30, 95% CI (0.25–0.37)] were less likely to have never heard of HIVST compared with individuals who were between 16 and 19 years old, who had a lower educational level and who had never tested for HIV before, respectively. In addition, non-household heads or household head representatives [aOR = 1.21, 95% CI (1.01–1.45)] were more likely to report never having heard of HIVST compared to household head and representatives. Conclusions Around one fifth of survey participants remain unaware of HIVST even after an intensive community-based door-to-door HIVST distribution. Of note, those least likely to have heard of self-testing were younger, less educated and less likely to have tested previously. Household heads appear to play an important role in granting or denying access to self-testing to other household members during door-to-door distribution. Differentiated distribution models are needed to ensure access to all. Trial registration PACTR, PACTR201607001701788. Registered 29 June 2016, https://pactr.samrc.ac.za/ PACTR201607001701788